The present disclosure relates generally to a combined coaxial and bimanual irrigation/aspiration (I/A) surgical instrument used in surgical procedures such as, for example, a phacoemulsification procedure.
The human eye functions to provide vision by transmitting light through a clear outer portion called the cornea, and focusing the image by way of a crystalline lens onto a retina. The quality of the focused image depends on many factors including the size and shape of the eye, and the transparency of the cornea and the lens. When age or disease causes the lens to become less transparent, vision deteriorates because of the diminished light which can be transmitted to the retina. This deficiency in the lens of the eye is medically known as a cataract. An accepted treatment for this condition is surgical removal of the lens and replacement of the lens function by an artificial intraocular lens.
In the United States, the majority of cataractous lenses are removed by a surgical technique called phacoemulsification. In the past, two different types of surgical instruments have been used during a phacoemulsification procedure, namely a coaxial instrument or a bimanual instrument. A typical coaxial instrument suitable for phacoemulsification procedures includes of an ultrasonically driven phacoemulsification hand piece, an attached hollow cutting needle surrounded by an irrigating sleeve, and an electronic control console. The hand piece assembly is attached to the control console by an electric cable and flexible tubing. Through the electric cable, the console varies the power level transmitted by the hand piece to the attached cutting needle. The flexible tubing supplies irrigation fluid to the surgical site and draws aspiration fluid from the eye through the hand piece assembly.
During the phacoemulsification procedure using the coaxial instrument, the tip of the cutting needle and the end of the irrigation sleeve are inserted into the anterior capsule of the eye through an incision in the outer tissue of the eye. The surgeon brings the tip of the cutting needle into contact with the lens of the eye, so that the vibrating needle tip fragments the lens. The resulting fragments are aspirated out of the eye through the interior bore of the cutting needle, along with irrigation solution provided to the eye during the procedure, and into a waste reservoir. However, because the irrigating sleeve surrounds the needle, the incision size necessary for insertion of the coaxial instrument into the eye has to be large enough to accommodate for the diameter of the coaxial instrument (e.g. the diameter of the end of the irrigation sleeve surrounding the tip of the cutting). Thus, while the coaxial instrument advantageously allows for a single piece instrument to perform irrigation and aspiration, its larger diameter size requires a large accommodating incision introducing more trauma at the surgical site.
The alternative surgical instrument used during a phacoemulsification procedure is commonly referred to as a bimanual instrument. The bimanual instrument, as the name implies, is actually two physically separate instruments. In that regard, one of the instruments is for irrigation and the other instrument is for aspiration. The aspiration instrument typically includes an ultrasonically driven phacoemulsification hand piece and an attached hollow cutting needle. The irrigation instrument includes a hand piece and an attached irrigation needle having irrigation ports. The aspiration and irrigation instruments are attached to a control console by electric cabling and flexible tubing. Through the electric cable, the console varies the power level transmitted by the hand piece to the attached cutting needle. The flexible tubing supplies irrigation fluid to the surgical site through the irrigation needle and draws aspiration fluid from the eye through the cutting needle.
During the phacoemulsification procedure using the bimanual instrument, the tips of the cutting and irrigation needles are inserted into the anterior capsule of the eye. Because the bimanual instrument is actually two separate instruments, the surgeon can make two separate incisions into the eye. Accordingly, the surgeon can insert the tips of the cutting needle and the irrigation needle into the separate incision sites. This allows for smaller incision sizes in the eye when compared to the phacoemulsification procedure using the coaxial instrument discussed above. Moreover, because the aspiration instrument does not have an irrigation sleeve surrounding the cutting needle, the diameter of the diameter of the distal end of the aspiration instrument is smaller than the distal end of the coaxial instrument. Again, this allows for a smaller incision sizes for the tip of the cutting needle for insertion into the eye when compared to the phacoemulsification procedure using the coaxial instrument discussed above. However, because a surgeon requires both aspiration and irrigation during a phacoemulsification procedure, typically both of the surgeon's hands are occupied with a respective instrument. Thus, during a phacoemulsification procedure using the bimanual instrument, the surgeon typically does not have an unoccupied or free hand available to further assist the surgeon.
The systems, devices, and methods disclosed herein overcome at least one of the shortcomings in the prior art.